This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Related articles in CJA Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mitchell, J. R. Articles by Ball, D. R. Search for Related Content PubMed PubMed Citation Articles by Mitchell, J. R. Articles by Ball, D. R.

Head computed tomography scan following cardiac arrest

Dumfries and Galloway Royal Infirmary, Dumfries, UK, E-mail: jmitchell2{at}nhs.net

To the Editor:

The recent recommendations for patient care following cardiac arrest¹ provide a useful, evidence-based approach to the management of this group of patients. However, some of the recommendations, especially those based on lower grades of evidence, probably need further debate.

The authors suggest that routine computed tomography (CT) of the head is not indicated (grade E evidence). We would argue that CT of the head is indicated in patients who remain unconscious following a cardiac arrest, especially those who are being considered for therapeutic hypothermia.

Kurkciyan and colleagues found that spontaneous subarachnoid hemorrhage (SAH) was the immediate cause of 4% of community cardiac arrests.² The majority of these patients had no prodromal symptoms to suggest an intracerebral event.

Therapeutic hypothermia may not be appropriate in patients who have suffered a SAH. There is no evidence of benefit of therapeutic hypothermia in this group of patients,³ and it is possible that 24 hr of therapeutic hypothermia followed by rewarming would lead to a delay in both the diagnosis of SAH and appropriate surgical intervention. Cooling to 32°C may cause a coagulopathy as a result of impaired enzyme activity and platelet function, which may be detrimental to patients with SAH.⁴

References

1 Bell DD, Brindley PG, Forrest D, Al Muslim O, Zygun D. Management following resuscitation from cardiac arrest: recommendations from the 2003 Rocky Mountain Critical Care Conference. Can J Anesth 2005; 52: 309–22.[Abstract/Free Full Text]

2 Kurkciyan I, Meron G, Sterz F, et al. Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest. Resuscitation 2001; 51: 27–32.[Medline]

3 Inamasu J, Ichikizaki K. Mild hypothermia in neurologic emergency: an update. Ann Emerg Med 2002; 40: 220–30.[Medline]

4 Wolberg AS, Meng ZH, Monroe DM 3rd, Hoffman M. A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma 2004; 56: 1221–8.[Medline]

Related articles in CJA:

REPLY

Dean D. Bell, Peter G. Brindley, Osama Al Muslim, and David Zygun
CJA 2005 52: 892-893. [Full Text]  

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Related articles in CJA Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mitchell, J. R. Articles by Ball, D. R. Search for Related Content PubMed PubMed Citation Articles by Mitchell, J. R. Articles by Ball, D. R.